Healthcare Provider Details

I. General information

NPI: 1679311336
Provider Name (Legal Business Name): VITAL LINK PHYSICIAN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W HOWARD ST
NILES IL
60714-3436
US

IV. Provider business mailing address

6201 W HOWARD ST
NILES IL
60714-3436
US

V. Phone/Fax

Practice location:
  • Phone: 847-774-7316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: EMANUEL ATKIN
Title or Position: MANAGEMENT
Credential:
Phone: 212-734-6621